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Original Research

Open Access

Establishing cutoff points for health-related fitness and metabolic risk factors in middle-aged men with metabolic syndrome

  • Tae-Jin Kwak1
  • Woo-Jin Choi2,*,†,
  • Gi-Chul Ha3,*,†,

1Department of Sports Science, Korea Institute of Sport Science, 05540 Seoul, Republic of Korea

2Department of Sports Rehabilitation, Cheongju University, 28503 Cheongju, Republic of Korea

3Department of Sports Medicine, National Fitness Center, 05540 Seoul, Republic of Korea

DOI: 10.22514/jomh.2025.099 Vol.21,Issue 7,July 2025 pp.79-90

Submitted: 16 April 2025 Accepted: 26 May 2025

Published: 30 July 2025

*Corresponding Author(s): Woo-Jin Choi E-mail: ssky61@cju.ac.kr
*Corresponding Author(s): Gi-Chul Ha E-mail: hagc@naver.com

† These authors contributed equally.

Abstract

Background: This study aimed to establish threshold values for health-related fitness and metabolic disease factors to provide practical evidence-based guidelines for the prevention of metabolic syndrome in middle-aged men. Methods: A total of 323 participants were classified into a metabolic syndrome group and a non-Metabolic syndrome (non-MetS) group based on established diagnostic criteria. Health-related fitness parameters, including muscular strength, muscular endurance, cardiorespiratory fitness and flexibility, as well as metabolic disease markers such as waist circumference, blood pressure and blood lipid profiles, were compared between groups using an independent t-test. Additionally, receiver operating characteristic curve analysis was employed to determine threshold values predictive of metabolic syndrome risk. Results: The metabolic syndrome group exhibited significantly higher body weight, body fat percentage and body mass index compared to the non-MetS group. Furthermore, metabolic disease markers, including waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, low-density lipoprotein cholesterol and hemoglobin A1c , were significantly elevated in the metabolic syndrome group. Conversely, health-related fitness levels were significantly lower. Receiver operating characteristic (ROC) curve analysis identified the following threshold values for health-related fitness: maximal oxygen consumption of 39.45 mL/kg/min, relative grip strength of 57.88% (left) and 60.36% (right), 29.5 repetitions for sit-ups, 20.5 repetitions for push-ups, 33.5 repetitions for side steps and a vertical jump height of 34.5 cm. The threshold values for metabolic disease markers were determined as follows: waist circumference ≥87.5 cm, systolic blood pressure ≥130.5 mmHg, diastolic blood pressure ≥77.5 mmHg, triglycerides ≥156.5 mg/dL, HbA1c ≥5.45% and high-density lipoprotein cholesterol ≤44.5 mg/dL. Conclusions: This study highlights the importance of maintaining metabolic markers below risk thresholds and enhancing health-related fitness to prevent metabolic syndrome in middle-aged men. Targeted exercise is key, and future studies should verify these thresholds across populations and assess long-term outcomes.


Keywords

Metabolic syndrome; Middle-aged men; Health-related fitness; Metabolic dieases factor; ROC curve analysis


Cite and Share

Tae-Jin Kwak,Woo-Jin Choi,Gi-Chul Ha. Establishing cutoff points for health-related fitness and metabolic risk factors in middle-aged men with metabolic syndrome. Journal of Men's Health. 2025. 21(7);79-90.

References

[1] Meigs JB. Invited commentary: insulin resistance syndrome? Syndrome X? Multiple metabolic syndrome? A syndrome at all? Factor analysis reveals patterns in the fabric of correlated metabolic risk factors. American Journal of Epidemiology. 2000; 152: 908–911; discussion 912.

[2] Hedblad B, Nilsson P, Engström G, Berglund G, Janzon L. Insulin resistance in non‐diabetic subjects is associated with increased incidence of myocardial infarction and death. Diabetic Medicine. 2002; 19: 470–475.

[3] Meigs JB. Epidemiology of the metabolic syndrome, 2002. American Journal of Managed Care. 2002; 8: S283–S292; quiz S293–6.

[4] Kim EJ, Lee EY, Lee YH, Choi YJ, Park SW, Lee EJ, et al. Combined effects of insulin resistance and inflammation on comorbidities of type 2 diabetes. The Journal of Korean Diabetes. 2021; 22: 207–219. (In Korean)

[5] Lim HJ, Kim EJ. Determining prevalence of metabolic syndrome among Korean adults using complex samples analysis. The Korean Journal of Measurement and Evaluation in Physical Education and Sport Science. 2017; 19: 85–97.

[6] Kim HJ, Kang DR, Kim JY, Kim W, Jeong YW, Chun KH. Metabolic syndrome fact sheet 2024: executive report. CardioMetabolic Syndrome Journal. 2024; 4: 70–80.

[7] Park CY. 2024 obesity fact sheet. 2024. Available at: https://general.kosso.or.kr/html/user/core/view/reaction/main/kosso/inc/data/2024_Obesity_Fact_sheet_web_kor1223.pdf (Accessed: 05 September 2024).

[8] Pérez-Martínez P, Mikhailidis DP, Athyros VG, Bullo M, Couture P, Covas MI, et al. Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation. Nutrition Reviews. 2017; 75: 307–326.

[9] Isomaa B, Almgren P, Tuomi T, Forsén B, Lahti K, Nissén M, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001; 24: 683–689.

[10] Lakka H-M, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002; 288: 2709–2716.

[11] Mohamed SM, Shalaby MA, El-Shiekh RA, El-Banna HA, Emam SR, Bakr AF. Metabolic syndrome: risk factors, diagnosis, pathogenesis, and management with natural approaches. Food Chemistry Advances. 2023; 3: 100335.

[12] Kim YJ. Metabolic syndrome and stroke. Journal of the Korean Neurological Association. 2005; 23: 585–594. (In Korean)

[13] Brambilla P, Pozzobon G, Pietrobelli A. Physical activity as the main therapeutic tool for metabolic syndrome in childhood. International Journal of Obesity. 2011; 35: 16–28.

[14] García-Hermoso A, Carrillo HA, González-Ruíz K, Vivas A, Triana-Reina HR, Martínez-Torres J, et al. Fatness mediates the influence of muscular fitness on metabolic syndrome in Colombian collegiate students. PLOS ONE. 2017; 12: e0173932.

[15] Han JM, Kim YS. Association between estimated cardiorespiratory fitness and insulin resistance in Korean adults: results from the Korea National Health and Nutrition Survey 2019–2021. Korean Society of Sports Medicine. 2023; 41: 233–240. (In Korean)

[16] An SH. Effect of cyclical short-time exercise on metabolic syndrome indicators and behavioral fitness. The Korea Journal of Sports Science. 2021; 30: 879–888. (In Korean)

[17] Camara M, Browne RAV, Souto GC, Schwade D, Lucena Cabral LP, Macêdo GAD, et al. Independent and combined associations of cardiorespiratory fitness and muscle strength with metabolic syndrome in older adults: a cross-sectional study. Experimental Gerontology. 2020; 135: 110923.

[18] Kim S. Association between cardiorespiratory fitness and metabolic syndrome in Korean older adults. International Journal of Environmental Research and Public Health. 2022; 19: 3671.

[19] Hong SY. Association of relative handgrip strength and metabolic syndrome in Korean older adults: Korea National Health and Nutrition Examination Survey VII-1. Journal of Obesity & Metabolic Syndrome. 2019; 28: 53–60.

[20] Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Preventive Veterinary Medicine. 2000; 45: 23–41.

[21] Caspersen CJ, Pereira MA, Curran KM. Changes in physical activity patterns in the United States, by sex and cross-sectional age. Medicine & Science in Sports & Exercise. 2000; 32: 1601–1609.

[22] Lee YK. Social perceptions of age and age norms. Journal of Population and Health Studies. 2021; 293: 38–54. (In Korean)

[23] Negida A, Fahim NK, Negida Y. Sample size calculation guide—part 4: how to calculate the sample size for a diagnostic test accuracy study based on sensitivity, specificity, and the area under the roc curve. Advanced Journal of Emergency Medicine. 2019; 3: e33.

[24] Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. Journal of Biomedical Informatics. 2014; 48: 193–204.

[25] Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. Journal of Clinical and Diagnostic Research. 2016; 10: YE01–TE06.

[26] Serdar CC, Cihan M, Yücel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochemia Medica. 2021; 31: 010502.

[27] Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001; 285: 2486–2497.

[28] Yoon YS, Oh SW. Optimal waist circumference cutoff values for the diagnosis of abdominal obesity in Korean adults. Endocrinology and Metabolism. 2014; 29: 418–426.

[29] Hyang-Beum L, Tae-Sang K, Kyoung-Mook L. Correlation between BMI, physical activity and indicators of metabolic syndrome in middle-aged adult. Journal of Korea Society for Wellness. 2021; 16: 387–394. (In Korean)

[30] Kim YI. 2018 National Health Screening Statistical Yearbook. National Health Insurance Service. 2019. Available at: https://www.nhis.or.kr/nhis/together/wbhaec07000m01.do?mode=view&articleNo=135196&article.offset=0&articleLimit=10 (Accessed: 27 February 2025).

[31] Seong SC. 2013 National Health Screening Statistical Yearbook. National Health Insurance Service. 2014. Available at: https://www.nhis.or.kr/nhis/together/wbhaec07000m01.do?mode=view&articleNo=113092&article.offset=10&articleLimit=10 (Accessed: 27 February 2025).

[32] Jung KS. 2023 National Health Screening Statistical Yearbook. National Health Insurance Service. 2024. Available at: https://www.nhis.or.kr/nhis/together/wbhaec07000m01.do?mode=view&articleNo=10848529&article.offset=0&articleLimit=10 (Accessed: 10 May 2025).

[33] Lee IY, Kim YH, Yu MH, Min D. Effect of the muscle strength exercise in middle aged people on risk factors for metabolic syndrome: using data from the 8th first years national health and nutrition examination survey (2019). Journal of Muscle and Joint Health. 2022; 29: 1–10. (In Korean)

[34] Laaksonen DE, Lakka HM, Salonen JT, Niskanen LK, Rauramaa R, Lakka TA. Low levels of leisure-time physical activity and cardiorespiratory fitness predict development of the metabolic syndrome. Diabetes Care. 2002; 25: 1612–1618.

[35] Atlantis E, Martin SA, Haren MT, Taylor AW, Wittert GA; Members of the Florey Adelaide Male Ageing Study. Inverse associations between muscle mass, strength, and the metabolic syndrome. Metabolism. 2009; 58: 1013–1022.

[36] Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian Journal of Internal Medicine. 2013; 4: 627–635.

[37] Gierach M, Gierach J, Ewertowska M, Arndt A, Junik R. Correlation between body mass index and waist circumference in patients with metabolic syndrome. International Scholarly Research Notices. 2014; 2014: 514589.

[38] Park SH, Choi SJ, Lee KS, Park HY. Waist circumference and waist-to-height ratio as predictors of cardiovascular disease risk in Korean adults. Circulation Journal. 2009; 73: 1643–1650.

[39] Tucker LA. Insulin resistance and biological aging: the role of body mass, waist circumference, and inflammation. BioMed Research International. 2022; 2022: 2146596.

[40] Havel PJ. Control of energy homeostasis and insulin action by adipocyte hormones: leptin, acylation stimulating protein, and adiponectin. Current Opinion in Lipidology. 2002; 13: 51–59.

[41] Holst D, Grimaldi PA. New factors in the regulation of adipose differentiation and metabolism. Current Opinion in Lipidology. 2002; 13: 241–245.

[42] Tian X, Chen S, Wang P, Xu Q, Zhang Y, Luo Y, et al. Insulin resistance mediates obesity-related risk of cardiovascular disease: a prospective cohort study. Cardiovascular Diabetology. 2022; 21: 289.

[43] Tziomalos K. Secondary hypertension: novel insights. Current Hypertension Reviews. 2020; 16: 11.

[44] Kjeldsen SE, Naditch-Brule L, Perlini S, Zidek W, Farsang C. Increased prevalence of metabolic syndrome in uncontrolled hypertension across Europe: the Global Cardiometabolic Risk Profile in Patients with hypertension disease survey. Journal of Hypertension. 2008; 26: 2064–2070.

[45] Silveira Rossi JL, Barbalho SM, Reverete de Araujo R, Bechara MD, Sloan KP, Sloan LA. Metabolic syndrome and cardiovascular diseases: going beyond traditional risk factors. Diabetes/Metabolism Research and Reviews. 2022; 38: e3502.

[46] Lee JH. Response of acute treadmill exercise on blood pressure and vascular compliance in essential hypertension patients. Exercise Science. 2003; 12: 267–276. (In Korean)

[47] Kang SJ, Baek UH. The effects of vascular elasticity acute aerobic exercise in the metabolic syndrome. Journal of Korea Entertainment Industry Association. 2013; 7: 173–179. (In Korean)

[48] The Korean Society of Lipid and Atherosclerosis (KSoLA); Committee of Clinical Practice Guideline. Korean Guidelines for the Management of Dyslipidemia (the 5th edition). 2022. Available at: https://lipid.or.kr/reference/guideline.php?boardid=guideline&mode=view&idx=1281&sk=&sw=&offset=&category= (Accessed: 10 March 2025).

[49] Cho HK. Diabetes mellitus and disorder of lipid metabolism. Endocrinology and Metabolism. 2006; 21: 101–105.

[50] Barone Gibbs B, Hivert MF, Jerome GJ, Kraus WE, Rosenkranz SK, Schorr EN, et al. Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: who, what, and how?: a scientific statement from the American Heart Association. Hypertension. 2021; 78: e26–e37.S

[51] Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, et al. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk). The BMJ. 2001; 322: 15–18.

[52] Ceriello A, Lucisano G, Prattichizzo F, La Grotta R, Franzén S, Svensson AM, et al. HbA1c variability predicts cardiovascular complications in type 2 diabetes regardless of being at glycemic target. Cardiovascular Diabetology. 2022; 21: 13.


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